Practice patterns among reproductive endocrinologists: Further aspects of the infertility evaluation

Objective: To characterize infertility testing in clinical practice. Design: A cross-sectional study assessing differences in clinical practice based on identifiable practitioner variables, such as gender, age, and type of practice. Setting: A population-based national survey. Participant(s): U.S. board-certified reproductive endocrinologists. Main Outcome Measure(s): Physicians' preferences in the interpretation and performance of the semen analysis, postcoital test (PCT), hysterosalpingography (HSG), laparoscopy, immunologic testing, hamster egg penetration assay, and screening for the luteinized unruptured follicle syndrome. Result(s): Younger physicians more often favor the use of Kruger strict morphology for the semen analysis, rely on urine or blood LH measurements for the timing of the PCT, and use a less strict cutoff for the definition of a normal PCT. About half of all physicians use antibiotic prophylaxis before HSG and 90% rely on water- soluble dye for imaging. Eighty percent of physicians in western U.S. practices schedule diagnostic laparoscopy during the follicular phase compared with 50% of their East Coast colleagues. Two thirds of physicians would conduct immunologic testing for infertility, but most would not use the hamster egg penetration test or screen for the luteinizing unruptured follicule syndrome. Conclusion(s): Although most board-certified reproductive endocrinologists agree on the major areas of the performance of infertility testing, there was significant variability in the details of the performance of most testing, especially with respect to physician age and geographic location.